Aligning Reimbursement With Quality: Are We There Yet?

On the first day of The Community Oncology Conference: Innovation in Cancer Care, held in Orlando, Florida, April 13-15, 2016, oncologists discussed how their practices are coping with the transition toward quality- and value-based reimbursement. The challenges they face and the changes they have been making in their clinic to provide evidence that the care they deliver follows guidelines and supports quality care.

The panel, Aligning Physician Compensation to Quality and Value, saw participation by Randy Broun, MD, president and chairman of the Board of Directors, Oncology Hematology Care, Inc; Michael Diaz, MD, an oncologist with the Florida Cancer Specialists & Research Institute; Rich Schiano, CEO of Oncology Hematology Care; and Todd Schonherz, COO, Florida Cancer Specialists and Research Institute, participated on the panel.

Lucio Gordon, MD, medical oncologist with Florida Cancer Specialists & Research Institute, moderated the discussion, and asked the panelists about their efforts to inculcate quality metrics in their practice and associating it with their compensation.

Schiano said, “We used an outside consultant to align quality with reimbursement. They initially built a metric of specific measures, satisfaction, compliance, adherence to pathways etc into the system. Then, later we included metrics for advanced practice providers as well.”

“We want the entire practice to achieve its quality and value metrics,” explained Diaz. “We are still in the process of defining value—there’s still a lot of debate about optimal quality measures. So focusing on moving targets wouldn’t help us.” Diaz emphasized that their overall approach is that every physician should have the opportunity to succeed, and Todd Schonherz, he said, help their practice with the value and quality metrics.

Schonherz said that NCCN guidelines have been the standard used for care delivery at their clinic. “We have many clinics with extended and weekend hours and we are also planning on a walk-in clinic,” he said. This provides a lot of flexibility to the patients and can prevent them from getting to the emergency department (ED) or a hospital setting for any complications or side effects. Schonherz emphasized the importance of patient feedback in the performance of their practice. “Our compensation is driven by how we perform and how our patients rate us,” he added.

Broun explained how their clinic has been working to adapt to this transition. “Oyr computer systems were also redone by a consultant who built-in quality measures. It’s important however, that these metrics be specific for each department— the metrics that apply to medical oncologists may not apply to radiation oncologists or to those who conduct bone marrow transplants,” Broun said. He said that although there are several things that are not within physician control, “But we have largely succeeded in getting the 5% of compensation for our physicians.”

Schiano said that while their physicians are extremely competitive, “There is a net promoter in each practice among consumers—our patients. This patient can be held as an ideal for all doctors to achieve,” he said and the patients in their turn help and bring value back to the practice.

“We have talked to payers about the volume-to-value movement. These are not simple agreements that we can draw out—they are not a sprint, more a marathon. We have been developing programs and creating infrastructure to support that because we want to be here for the long-term for our patients,” said Schonherz.

Broun then brought up a really good point on data analytics. “Doctors do not like bad analytics,” he said. “Bad numbers always mean doctors get upset with the data they are presented with.” When asked to prove otherwise, they go back and pull out the individual patient charts as proof.

This then led to the discussion on how the analytics can then be translated into real-time use in the clinic. “We are focused on developing a level of real-time transparency that would be readily visible to the doctors to build and apply,” Schiano said. He insisted though that the entire staff at the clinic needs to be trained and on board to make this system work. “You need to get this data out in front of the staff and discuss it with them. We are constantly thinking about engaging every segment of the office, including those at the front desk.”

“How about the patients—do they care that we are aligning our compensation with quality?” asked Gordon.

“I think they would be,” replied Diaz. “In the big picture of things, they are aware of other surveys and what other patients think. Beyond that, it might be too technical for them to grasp additional details.”

The bottom line though is gathering sufficient data. “Data is an important driver. If data shows you are operating within pathways, you are operating at low costs, and you take it back to the healthcare system, it helps,” explained Schiano. “Analytics help support your clinic’s performance. We need to ensure we have the right architecture and that we are gathering the right data that can help sculpture the information being presented to guarantee it tells the real story,” he added.

The Oncology Medical Home model has been initiated by several clinics within the country and Gordon wanted the panelists to comment on where the model stands.

“We have a weekend clinic, which helps patients. They can just walk in and be able to see a provider, usually an advanced practice nurse. We also have patient navigators to help patients navigate the healthcare system as well as the financial aspects of care,” Broun said.

Schonherz said that Florida Cancer Specialists too have extended and weekend hours at their clinics. “We have been initiating discussions with urgent care centers to use them as a way to avoid ED or other hospital visits that are more expensive.

“Ideally, we want a universal agreement on the quality metrics. We have to take it one-step at a time,” said Diaz